Discussion of public health and health care policy, from a public health perspective. The U.S. spends more on medical services than any other country, but we get less for it. Major reasons include lack of universal access, unequal treatment, and underinvestment in public health and social welfare. We will critically examine the economics, politics and sociology of health and illness in the U.S. and the world.

Wednesday, September 16, 2009

Insanity

One well-known definition is doing the same thing repeatedly and expecting a different result. The legislation emerging in the congress right now looks a whole lot like the Massachusetts health care reform legislation with which we now have two years worth of good experience. Reporteth the Boston Globe:

The state’s major health insurers plan to raise premiums by about 10 percent next year, prompting many employers to reduce benefits and shift additional costs to workers.

Increases will range from 7 to 12 percent, capping a decade of consecutive double-digit premium increases, according to a Globe survey of the state’s top health insurers. Actual rates for 2010 will depend on the size of the employer and the type of coverage, with small businesses and individuals expected to be hit hardest. Overall, premiums are more than twice as high as they were 10 years ago.

Oh yeah -- the state is broke so it remains to be seen what will happen to the subsidies that make insurance somewhat -- although often not really -- affordable for moderate income people, but simple arithmetic says it will get ugly. I also happen to be in possession of some secret knowledge about what has been happening to "universal coverage" but it's embargoed until tomorrow so I'll play by the rules on that.

“Health insurance is increasingly unaffordable for average working people and for employers, especially small employers,’’ said Drew Altman, president of the Kaiser Family Foundation, a nonprofit research group in Menlo Park, Calif. “It underscores the need to reach a consensus on how to reform health care and provide some help for low- and moderate-income people who can’t pay their insurance bills.’’

Well, the legislation we're looking at does essentially nothing to control costs. It will force people to buy insurance, no matter what it costs, which means the insurers will be free to gouge us all they want and will have essentially no incentive to try to rein in overuse; doctors and hospitals and other providers will still be paid more to do more; and we won't have any institutional mechanisms for sorting out effective and cost effective interventions from ones that are only effective at enriching doctors and drug companies.

Result: costs will keep going up, the cost to the treasury for Medicare and Medicaid and whatever new subsidies are introduced for moderate income people to buy insurance on the open market will just go up and up, and insurance will become less and less affordable and mandate or no, universal coverage will slip farther and farther away while the medical-industrial complex continues to bleed us dry.

I've been wondering...How do you turn the system we have, where several discrete, private, profit-based businesses provide Americans health insurance (in doing so, according to Obama, contribute a sixth of GDP), into a single-payer, government-managed (and subsidized?) system?Not being contrary. I think single-payer makes the most sense. But I don't know how you get there from here.